妊娠早中期持续孤立性低甲状腺素血症对妊娠期并发症及不良结局的影响  

Effects of persistent isolated hypothyroxinemia in the first and second trimester of pregnancy on complications and adverse outcomes of pregnancy

作　　者：金辉 陈方圆 吴跃跃 刘军 黄新梅 陈灶萍 盛励 徐炯 查兵兵 杨孟雪 于志艳 张瑞 李悦 Jin Hui;Chen Fangyuan;Wu Yueyue;Liu Jun;Huang Xinmei;Chen Zaoping;Sheng Li;Xu Jiong;Zha Bingbing;Yang Mengxue;Yu Zhiyan;Zhang Rui;Li Yue(Pharmacy Department,Shanghai Fifth People′s Hospital Affiliated to Fudan University,Shanghai 200240,China;Department of Endocrinology,Shanghai Fifth People′s Hospital Affiliated to Fudan University,Shanghai 200240,China)

机构地区：[1]复旦大学附属上海市第五人民医院药剂科,200240 [2]复旦大学附属上海市第五人民医院内分泌科,200240

出　　处：《中华内分泌代谢杂志》2022年第1期19-23,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市医学重点专科建设计划(ZK2019B15)。

摘　　要：目的探讨妊娠早中期持续孤立性低甲状腺素血症对妊娠期并发症及不良结局的影响。方法回顾性分析2016年4月至2017年4月在本院产科分娩的妊娠早中期持续孤立性低甲状腺素血症孕妇111例,选取同期妊娠期甲状腺功能正常孕妇673例作为对照组,分析2组妊娠期并发症及不良结局。结果妊娠早中期持续孤立性低甲状腺素血症组的年龄、孕前体重、体重指数(BMI)、口服糖耐量试验1 h血糖、2 h血糖均大于或者高于妊娠期甲状腺功能正常组(P<0.05),妊娠期贫血发生率显著增高(P<0.05),而妊娠期糖尿病及妊娠期高血压的发生率2组之间差异未见明显的统计学意义(P>0.05)。2组的巨大儿、死产、新生儿畸形、产后出血、急产、早产、胎儿宫内发育延迟、足月小于胎龄儿差异均无明显的统计学意义(P>0.05)。Logistic回归分析显示,年龄(OR=1.1,95%CI 1.0~1.1,P=0.002)、孕前体重(OR=1.0,95%CI 1.0~1.1,P=0.046)是妊娠早中期持续孤立性低甲状腺素血症发生的危险因素。而妊娠早中期持续孤立性低甲状腺素血症与妊娠期贫血相关(OR=1.9,95%CI 1.1~3.2,P=0.024)。结论妊娠年龄较大及妊娠前体重较重的孕妇需要关注甲状腺功能,妊娠早中期持续孤立性低甲状腺素血症的孕妇需要关注是否存在贫血。Objective To investigate the effects of persistent isolated hypothyroxinemia in the first and second trimester of pregnancy on complications and adverse outcomes of pregnancy.Methods A retrospective analysis was conducted in 784 pregnant women including 111 cases of persistent isolated hypothyroxinemia in the first and second trimester of pregnancy and 673 pregnant women with normal thyroid function as control group.All women were registered and delivered in the Department of Obstetrics of our hospital from April 2016 to April 2017.The complications and adverse outcomes of pregnancy in the two groups were analyzed.Results Age,body weight before pregnancy,body mass index(BMI),1 h plasma glucose and 2 h plasma glucose during oral glucose tolerance test in persistent isolated hypothyroxinemia group were higher than those in control group(P<0.05),with increased incidence of anemia during pregnancy(P<0.05).However,there were no significant differences in the incidences of gestational diabetes mellitus and gestational hypertension between the two groups(P>0.05).No significant statistical differences were found in macrosomia,stillbirth,neonatal malformation,postpartum hemorrhage,acute delivery,premature delivery,fetal intrauterine development delay,and small full-term infants between the two groups(P>0.05).Logistic regression analysis showed that age(OR=1.1,95%CI 1.0-1.1,P=0.002)and pre-pregnancy body weight(OR=1.0,95%CI 1.0-1.1,P=0.046)were risk factors for the occurrence of persistent isolated hypothyroxinemia in the first and second trimesters of pregnancy.Persistent isolated hypothyroxinemia in the first and second trimesters was associated with anemia during pregnancy(OR=1.9,95%CI 1.1-3.2,P=0.024).Conclusions Pregnant women who are older and heavier before pregnancy should pay more attention to their thyroid function.Pregnant women with persistent isolated hypothyroxinemia in the first and second trimesters should be concerned for anemia.

关 键 词：妊娠期 孤立性低甲状腺素血症 并发症 不良结局 

分 类 号：R714.25[医药卫生—妇产科学]